Review Reports - Methods for Chin Area Augmentation: Efficacy Evaluation and Prospects for Using Subplatysmal Fat Autograft

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is an interesting article that analyzes two chin augmentation techniques.

- In the Abstract, should be emphasizing novelty of this chin augmentation technique but should be better underlined that bony genioplasty remains the most effective technique for correcting aesthetic defects of the mandible.

- The introduction is quite clear.

- M&M section should be more specified about statistical analysis and selection biases

- In Discussion section should be expanded on how the findings compare to prior studies and addressed more explicitly limitations (such as variability in autograft survival or follow-up period disparities)

- Conclusion could be strengthened by outlining potential future research directions.

Author Response

Comments 1: This is an interesting article that analyzes two chin augmentation techniques.

Response 1: Dear reviewer, thank you for your time reviewing our article and for your valuable comments.

We have added the required information the required information about bony genioplasty in the abstract section as requested.

Comments 2: The introduction is quite clear.

Response 2: Thank you for your high regard for our research paper.

Comments 3: M&M section should be more specified about statistical analysis and selection biases

Response 3: Thank you for your valuable comment regarding the Materials and Methods section, we added and specified the methods used for the statistical analysis and criteria in the materials and methods section as requested.

Comments 4: In Discussion section should be expanded on how the findings compare to prior studies and addressed more explicitly limitations (such as variability in autograft survival or follow-up period disparities)

Response 4: Thank you for your valuable comment

As requested, the discussion section was expanded, detailing more information about the limitations. The graft survival is very good and information regarding the graft is added in the revised manuscript.

Regarding the follow up period, we want to add that, unfortunately, patients come for control visits when they have time, since many of them are not locals, even though we wanted them to come more regularly for check ups, and so we have been transparent about this in our manuscript

Comments 5: Conclusion could be strengthened by outlining potential future research directions

Response 5: We expanded the conclusion with the information about the potential future research directions. Thank you for your time and valuable comments

Reviewer 2 Report

Comments and Suggestions for Authors

I recommend the authors consider the following improvements:

1. The authors do not explicitly discuss limitations such as the retrospective design, lack of randomization and control, variability in surgeon expertise. I advise to include a dedicated limitations section addressing these points and their impact on the findings.

2. While most references are relevant, some appear tangential to the primary focus of the study. For instance, references discussing early 20th-century techniques may be less impactful for a study emphasizing modern surgical methods. I advise to retain key historical references but prioritize citations that directly contribute to the study's hypothesis and methodology.

3. Since you used ultrasonography to evaluate the chin’s soft tissues, I would find it very useful to give more details about the role of ultrasound in lipofilling procedures. For example, how do fat grafts appear on US images? What is the role of Doppler US imaging in this type of procedures?

Please see this paper: Beiu, C.; Popa, L.G.; Bălăceanu-Gurău, B.; Iliescu, C.A.; Racoviță, A.; Popescu, M.N.; Mihai, M.M. Personalization of Minimally-Invasive Aesthetic Procedures with the Use of Ultrasound Compared to Alternative Imaging Modalities. Diagnostics 2023, 13, 3512. https://doi.org/10.3390/diagnostics13233512

4. The conclusions align with the reported results, highlighting the advantages of subplatysmal fat autograft over implants. However, the claim of long-term safety and efficacy requires more substantial evidence, given the average follow-up period. I advise the authors to acknowledge the limitations of follow-up duration and the need for further longitudinal studies.

Author Response

Comments 1: I recommend the authors consider the following improvements:

The authors do not explicitly discuss limitations such as the retrospective design, lack of randomization and control, variability in surgeon expertise. I advise to include a dedicated limitations section addressing these points and their impact on the findings.

Response 1: Dear reviewer, thank you for your time and valuable comments to help improve our manuscript.

We added a dedicated limitations section in our manuscript as requested.

Comments 2: While most references are relevant, some appear tangential to the primary focus of the study. For instance, references discussing early 20th-century techniques may be less impactful for a study emphasizing modern surgical methods. I advise to retain key historical references but prioritize citations that directly contribute to the study's hypothesis and methodology.

Response 2: The authors want to thank you for your insightful comments.

We understand your comment and we believe that in order for our manuscript to retain its ideas and correctly address the methods, we need to include the available literature that discusses different methods, however, the reference section was improved, and more relevant references were added as you requested. Thank you

Comments 3:

Since you used ultrasonography to evaluate the chin’s soft tissues, I would find it very useful to give more details about the role of ultrasound in lipofilling procedures. For example, how do fat grafts appear on US images? What is the role of Doppler US imaging in this type of procedures?

Response 3: The authors want to thank you for your comments and questions and for providing us with a very interesting paper to read. We have carefully studied it.

Ultrasound is very helpful in evaluating the soft tissues in general as well as the areas with lipofilling. On the Ultrasound images, the injected fat would look like hypoechoic, darker areas compared to the surrounding tissues. Doppler Ultrasound is used to monitor and assess the vascularization ensuring that the grafted area has adequate blood flow, which is vital for graft survival. This combination allows for precise monitoring of fat grafts, enhancing the safety and effectiveness.

Regarding the Doppler Ultrasound images, the circulation in the fat autograft is mildly expressed in the Doppler Ultrasound images due to the fact that the probe can not easily detect such minor circulatory changes, but the circulation is present and good, at the same time, in the recipient zone, we have a very pronounced circulation due to peripheral arteries.

In the histological samples, we can also clearly see the arterioles, venules and capillaries which prove that the circulation in the fat autograft is present.

Comments 4: The conclusions align with the reported results, highlighting the advantages of subplatysmal fat autograft over implants. However, the claim of long-term safety and efficacy requires more substantial evidence, given the average follow-up period. I advise the authors to acknowledge the limitations of follow-up duration and the need for further longitudinal studies.

Response 4: The authors would like to thank you for your valuable comments which helped improve our manuscript. We added and acknowledged the information in our manuscript as requested. Thank you for your time